The current project "Efficacy Studies in Dental Radiology" has produced significant findings relative to the sensitivity and specificity of dental radiographs, the incremental yield of various radiographic projections, and the use of clinical indicators in selecting patients for radiographic examination. A major finding that runs across the findings to date is the consistant presence of false negative and false positive radiographic readings. The objective of the continuation study is to analyze the nature and consequences of the resulting incorrect diagnosis and to develop diagnostic algorithms for limiting its occurrence. The specific aims and methods are: (1) to identify the rates of incorrect diagnosis (false positive and false negative) in the evaluation of dental disease; (2) to evaluate the consequences, both in the short term and long term, of incorrect diagnosis in dentistry from qualitative and quantitative perspectives; (3) to evaluate the various states of health which may result from the correct and incorrect diagnosis of dental disease; (4) to develop algorithms which limit the consequences of incorrect diagnosis, through an analysis of patient examination strategies that will combine different sets of clinical indicators with different radiographic strategies, and using various biological and economic assessments of the consequences; (5) to apply and test new statistical methods for analyzing longitudinal dichotomous outcomes in the evaluation of dental disease and treatment; (6) to conduct a review of legal issues related to the development and use of selection criteria for dental radiography. The significant health implications of these analyses relate to identifying the kind and extent of the clinical consequences of incorrect diagnosis that results from the use of dental radiographs. The risks and benefits associated with false negative readings (which increase with fewer radiographs) and false positive radiographs (which increase with many radiographs) will provide critical information to clinicians as well as administrators of dental care financing and delivery systems.